AB0914 CARDIOVASCULAR RISK FACTORS ARE ASSOCIATED WITH INCREASED CRP LEVELS IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: M. G. Abdelzaher, D. Feldmann, U. Heilmeier, I. Jandova, F. Kollert, R. Voll, S. Finzel
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with systemic sclerosis (SSc) are known to have an elevated risk for cardiovascular diseases. Approximately 20-25% of all SSc patients have permanently elevated C-reactive protein (CRP) levels [1,2]. Higher CRP levels are known to be associated with metabolic syndrome and diabetes mellitus (DM) (3), two factors that contribute to cardiovascular risk. <h3>Objectives</h3> To investigate if permanently elevated CRP levels are associated with higher cardiovascular risk in a cohort of 65 patients with SSc. <h3>Methods</h3> Data analysis was carried out in R 4.1 using the packages dplyr, ggplot2, mice and MASS. 65 patients were enrolled in the study; 20 had permanently elevated CRP levels over two years before enrollment (CRP+ group), and 45 had normal CRP levels over 2 year prior enrollment (CRP- group). The following cardiovascular risk factors were selected as candidate predictors of CRP status: The Framingham Score, left and right carotid intima-media thickness (CIMT) on bilateral carotid ultrasound, pathological status of both carotids, presence of plaques in both carotids, number of plaques (0 if none), extent of largest plaque (0 if none), height, weight, body mass index (BMI), presence of arterial hypertension, history of smoking, packyears, DM type 2, chronic kidney disease, and a positive family history (cardiovascular event before the age of 65). We tested each variable as a bivariate predictor of CRP status in a logistic regression model. Subsequently, we used stepwise logistic regression based on the Akaike Information Criterion (AIC) to determine the optimal set of predictors. AIC evaluates model deviance in relation to the number of variables in the model, i.e., it can be used to find the optimal trade-off between model performance (predictive accuracy) and model complexity (number of predictors). Prior to logistic regression analysis, missing values in the dataset were replaced by means of multiple imputation. <h3>Results</h3> In the bivariate logistic regression analyses (Table 1), only the Framingham Score and DM2 were identified as significant predictors, both with a positive weight, i.e., a higher Framingham Score and the presence of DM2 in a given patient were predictive of permanently positive CRP status, respectively. However, due to relatively low sample size, model sensitivity was 65%, and specificity was 86.7%. <h3>Conclusion</h3> Permanently increased CRP levels are associated with higher Framingham scores and DM type 2 in SSc-patients. These findings are going to be validated in larger and longitudinal cohorts. <h3>References</h3> [1]<b>Mitev A</b>, et al. Arthritis Res Ther. 2019 Dec 2;21(1):262. [2]<b>Muangchan C</b>, et al. Arthritis Care Res (Hoboken). 2012 Sep;64(9):1405-14. [3]<b>Chambers JC,</b> et al. Circulation. 2001 Jul 10;104(2):145-50. Characters from table 1: Title: Results of bivariate logistic regression analyses. Footnotes: For each candidate predictor variable, the odds ratio (OR) along with its t-value and p-value are given. An OR greater than 1 indicates that a higher value in the respective candidate predictor variable (or response 'yes' for categorical candidate predictor variables) is associated with a higher probability of belonging to CRP-positive group. <h3>Acknowledgements</h3> We thank Dr. Marius Keute, an employee of Ortmann Statistics, for his support with statistical calculations. <h3>Disclosure of Interests</h3> Mohamed Gamal Abdelzaher: None declared, Daria Feldmann: None declared, Ursula Heilmeier: None declared, Ilona Jandova: None declared, Florian Kollert Employee of: Novartis, Reinhard Voll Speakers bureau: Novartis, Roche, Janssen, Galapagos, Pfizer, Astra Zeneca, Böhringer Ingelheim, Consultant of: Novartis, Roche, Janssen, Galapagos, Astra Zeneca, Böhringer Ingelheim, Grant/research support from: Novartis, Pfizer, BMS, Stephanie Finzel Speakers bureau: Novartis, Galapagos, Amgen, Abbvie, Paid instructor for: Novartis, Galapagos, Amgen, Abbvie, Consultant of: Novartis, Amgen, Novonordisk, Grant/research support from: Novartis, Sobi.